Sat Mar 04 2023

92 articles - From Saturday Feb 25 2023 to Saturday Mar 04 2023

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Guidelines

Guidelines and related publications, position statements, white papers, technical reviews, consensus statements, etc…

Am J Gastroenterol

ACG Clinical Guideline: Diagnosis and Management of Biliary Strictures.

Recent evidence has provided some clarity in multiple important areas pertaining to biliary strictures, whereas several remaining controversies require additional research. The goal of this guideline is to provide practicing clinicians with the most evidence-based guidance on the approach to patients with extrahepatic and perihilar strictures, focusing on diagnosis and drainage.

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Correction to: American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease.

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J Hepatol

International Liver cancer Association (ILCA) White Paper on Hepatocellular carcinoma Risk Stratification and Surveillance.

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Meta-analysis

meta-analyses and systematic reviews

Aliment Pharmacol Ther

Randomised, placebo-controlled trial and meta-analysis show benefit of ondansetron for irritable bowel syndrome with diarrhoea: The TRITON trial.

Although small numbers meant the primary endpoint was not met in this trial, when pooled with other similar trials meta-analysis suggests ondansetron improves stool consistency and reduces days with loose stool and urgency.

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Clin Gastroenterol Hepatol

Systematic Review and Meta-analysis: Efficacy of Mesalamine in Irritable Bowel Syndrome.

Mesalamine may be modestly efficacious for global symptoms in IBS, particularly IBS with diarrhea, but quality of evidence was low. Adequately powered high quality RCTs of mesalamine in IBS are needed.

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Endosc Int Open

Global trends in training and credentialing guidelines for gastrointestinal endoscopy: a systematic review.

While some metrics such as ADR were relatively consistent among societies, there was substantial variation among societies with respect to procedural volume and KPI statements.

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Endoscopy

Comments on: "Long-term outcomes of peroral endoscopic myotomy for achalasia: a systematic review and meta-analysis".

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Gastrointest Endosc

Long-term outcomes of local resection versus surgical resection for high-risk T1 colorectal cancer: A systematic review and meta-analysis.

For high-risk T1 CRC patients, the net benefit of DSS appears to be significant when the observation period exceeds 10 years. A long-term net benefit may exist but may not be applicable to al patients, especially high-risk patients with comorbidities. Therefore, LR may be a reasonable alternative for individualized treatment for some high-risk T1 CRC patients.

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J Hepatol

Anticoagulation improves survival in patients with cirrhosis and portal vein thrombosis: The IMPORTAL competing-risk meta-analysis.

Anticoagulation reduces all-cause mortality in patients with cirrhosis and portal vein thrombosis independently of recanalization, but at the expense of increasing non-portal hypertension related bleeding IMPACT AND IMPLICATIONS PROSPERO REGISTRATION NUMBER CRD42020140026.

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Original articles

RCT, clinical trials, retrospective studies, etc…

Aliment Pharmacol Ther

Effectiveness of golimumab intensification in ulcerative colitis: A multicentric prospective study.

In this prospective multicentric study, half of patients recaptured response following golimumab intensification in UC. Therapeutic drug monitoring did not predict response after optimisation of golimumab.

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Mitochondrial respiratory chain activity is associated with severity, corticosteroid response and prognosis of alcoholic hepatitis.

Our results indicate that MRC activity is markedly decreased in the liver of AH patients, and, particularly, the impairment of MRC complexes I and III activity appears to have a significant impact on the clinical outcomes of patients with AH.

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Am J Gastroenterol

Is Vaccination Against COVID-19 Associated With Inflammatory Bowel Disease Flare? Self-Controlled Case Series Analysis Using the UK CPRD.

Vaccination against COVID-19 was not associated with IBD flares regardless of prior COVID-19 infection and whether messenger RNA or DNA vaccines were used.

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The impact of patient age and corticosteroids in patients with Sulfonamide hepatotoxicity.

Sulfonamide hepatotoxicity is characterized by a short drug latency with frequent hypersensitivity features at onset. Subject age is an important determinant of the laboratory profile at presentation and patients with cholestasis and higher total bilirubin levels were at increased risk of developing chronic DILI. Corticosteroids may benefit a subgroup of patients with severe injury but further studies are needed.

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Clin Gastroenterol Hepatol

Diabetes mellitus impacts on the performance of hepatocellular carcinoma risk scores in chronic hepatitis B patients.

REAL-B score is accurate and preferred in entecavir/tenofovir-treated CHB patients given the increasing prevalence of DM.

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Novel Symptom Subgroups in Individuals with Irritable Bowel Syndrome Predict Disease Impact and Burden.

Our clusters identify groups of individuals with significant impairments in quality of life, earning potential, and ability to work and function socially, who are high utilizers of healthcare.

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Sarcopenia Among Patients with Nonalcoholic Fatty Liver Disease (NAFLD) is Associated with Advanced Fibrosis.

Patients with sarcopenic NAFLD are at risk for SF and AF. Increased physical activity and a healthy diet targeted to improve sarcopenic NAFLD could reduce the risk of significant fibrosis.

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Socioeconomic disparities affect outcomes in early-stage esophageal adenocarcinoma - a SEER analysis.

Lower median household income was associated with higher rates of cancer-specific mortality and lower rates of endoscopic resection in T1aN0M0 esophageal adenocarcinoma. Population-based strategies aimed at identifying and rectifying possible etiologies for these socioeconomic and geographic disparities are paramount to improving patient outcomes in early esophageal cancer.

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Endosc Int Open

Endoscopic full-thickness resection (EFTR) compared to submucosal tunnel endoscopic resection (STER) for treatment of gastric gastrointestinal stromal tumors.

This study demonstrated that although patients who received EFTR had longer hospital stays and slower resumption of diet compared to those who underwent STER, EFTR achieved a significantly higher rate of en-bloc resection compared to STER for treatment of gastric GIST.

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Endoscopic vacuum-assisted closure therapy for leakage of the lower gastrointestinal tract: multicenter experiences.

E-VAC therapy due to post-surgery leakage of the lower gastrointestinal tract is safe and effective. High levels of CRP are a negative predictor of E-VAC therapy success.

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EUS-guided cyanoacrylate injection into the perforating vein versus direct endoscopic injection in the treatment of gastric varices.

EUS-guided CYA injection into the perforating veins achieved less amount of CYA, fewer number of sessions to obliteration, and similar overall AE rates in the treatment of high-risk GVs compared to DEI.

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EUS-guided left lobe liver biopsy: Safer modality with similar diagnostic yield as right lobe: a pilot study.

EUS-guided left-lobe liver biopsy is safer than right-lobe biopsy with similar diagnostic yield.

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Prospective study on the efficacy of endoscopic through-the-scope tack and suture system for gastric peroral endoscopic myotomy mucosal incision site closure.

With experience, technical success is high, and most closures may be achieved using a single TTS suture system alone, which has important cost and time implications. Additional comparative trials with other closure devices are need1ed.

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Endoscopy

A simple clinical score can stratify the risk of procedure-related adverse events in ERCP procedures with trainee involvement.

Simple, clinical-based predictive tools, could improve ERCP training through an individualized selection of cases for hands-on training, with the aim of increasing patient safety.

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Appendiceal lesions in serrated polyposis patients are easily overlooked but only seldomly lead to colorectal cancer.

Appendiceal lesions are common in SPS patients. The discrepancy between the endoscopic detection rate of appendiceal lesions and the reported prevalence in surgically resected appendices suggests a substantial miss-rate of appendiceal lesions during colonoscopy. Advanced appendiceal lesions are however rare and no appendiceal adenocarcinomas occurred, implying limited clinical relevance of these lesions.

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ENDOSCOPIC VACUUM THERAPY FOR ESOPHAGEAL PERFORATION: A MULTICENTER RETROSPECTIVE COHORT STUDY.

EVT is a promising organ-preserving treatment for esophageal perforations, with a success rate of 89%. More experience with the technique and indications will likely improve success rate.

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Multicenter randomized trial comparing diagnosis sensitivity and cellularity abundance of aggressive and standard biliary brushing for bile duct stenosis without mass syndrome.

Sensitivity for cholangiocarcinoma was 34/43 (79%) for the Infinity brush versus 29/43 (67%) for the RX Cytology Brush (p = 0.096). Cellularity was rich in 31/51 (61%) cases with the Infinity brush and in 10/51 (20%) cases with the RX Cytology Brush (p .

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Zenker's peroral endoscopic myotomy for management of large Zenker's diverticulum.

This study demonstrated safe and effective use of zPOEM in the management of large Zenker's diverticulum.

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Gastroenterology

Colorectal Cancer Risk Assessment and Precision Approaches to Screening: Brave New World or Worlds Apart?

In order to envisage clinical implementation of precision screening in the future, it will be critical to develop reliable and accurate prediction models that apply to al individuals in a population, prospectively study risk-adapted CRC screening on the population level, garner acceptance from patients and providers, and assess feasibility, resources, cost, and cost-effectiveness of these new paradigms. This review evaluates the current state of risk prediction modeling and provides a roadmap for future implementation of precision CRC screening.

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Comparing time to diagnosis and treatment between younger and older adults with colorectal cancer: A population-based study.

Younger adults present more often with Stage IV colorectal cancer but have overall similar times from presentation to treatment as screening-eligible older adults.

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Disruption of SLFN11 deficiency-induced CCL2 signaling and macrophage M2 polarization potentiates anti-PD-1 therapy efficacy in hepatocellular carcinoma.

SLFN11 serves as a critical regulator of microenvironmental immune properties and an effective predictive biomarker of ICIs response in HCC. Blockade of CCL2/CCR2 signaling sensitized SLFN11 low HCC patients to ICI treatment.

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SPHINGOLIPIDS ARE DEPLETED IN ALCOHOL-RELATED LIVER FIBROSIS.

Alcohol-related liver fibrosis is characterized by selective and progressive lipid depletion in liver and blood, particularly sphingomyelins, which also associates with progression to liver-related events.

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Targeting UBE2T potentiates gemcitabine efficacy in pancreatic cancer by regulating pyrimidine metabolism and replication stress.

Collectively, UBE2T-mediated p53 degradation confers PC gemcitabine resistance by promoting pyrimidine biosynthesis and alleviating replication stress. This study offers an opportunity to improve PC survival by targeting UBE2T and develop a promising gemcitabine sensitizer in clinical translation setting.

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Gastrointest Endosc

A real-time interpretable artificial intelligence model for the cholangioscopic diagnosis of malignant biliary stricture.

The findings suggest that MBSDeiT could be a promising approach for the accurate diagnosis of MBS under DSOC.

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Effect of a deep learning-based automatic upper gastrointestinal endoscopic reporting system: a randomized crossover study.

AI-EARS showed its efficacy in improving the accuracy and completeness of the EGD reports. It might facilitate the generation of complete endoscopy reports and post-endoscopy patient management. (ClinicalTrails.gov, number NCT05479253).

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Endoscopic causes and characteristics of missed gastric cancers after endoscopic submucosal dissection.

We identified MGCs in four categories and clarified their characteristics. Quality improvements in EGD observation, with attention to the risks of perceptual and site of exposure errors, can potentially prevent missing EGCs.

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Gut

Definition of age-dependent reference values for the diameter of the common bile duct and pancreatic duct on MRCP: a population-based, cross-sectional cohort study.

This is the first population-based study delineating age-adjusted upper reference limits of CBD and PD on MRCP. We showed that up to 18.2% of healthy volunteers would have needed diagnostic workup, if the conventional reference values were used. The utilisation of the adapted reference levels may help to avoid unnecessary investigations and thus to reduce healthcare expenditure and test-related adverse events.

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Patient selection for urgent endoscopic retrograde cholangio-pancreatography by endoscopic ultrasound in predicted severe acute biliary pancreatitis (APEC-2): a multicentre prospective study.

In patients with predicted severe acute biliary pancreatitis without cholangitis, urgent EUS-guided ERCP with ES did not reduce the composite endpoint of major complications or mortality, as compared with conservative treatment in a historical control group.

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SDCBP promotes pancreatic cancer progression by preventing YAP1 from ß-TrCP-mediated proteasomal degradation.

SDCBP promotes the proliferation and metastasis of PDAC by preventing YAP1 from ß-TrCP-mediated proteasomal degradation. Therefore, ZnPT could be a promising therapeutic strategy to inhibit PDAC progression by suppressing SDCBP.

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Hepatology

Alcohol-induced extracellular asc specks perpetuate liver inflammation and damage in alcoholic hepatitis even after alcohol cessation.

Our study demonstrates the central role of NLRP3 and ASC in alcohol-induced liver inflammation and unravels the critical role of ex-ASC specks in the propagation of systemic and liver inflammation in AH. Our data also identify NLRP3 as a potential therapeutic target in AH.

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Gut microbiome-brain-cirrhosis axis.

Clinical studies and animal models have demonstrated significant patterns of gut dysbiosis when cirrhosis is present, both with or without concomitant alcohol use disorder, and have provided compelling evidence that this dysbiosis also influences cognitive and mood-related behaviors. In this review, we have summarized the pathophysiological and cognitive effects associated with cirrhosis, links to cirrhosis-associated disruption of the gut microbiome, and the current evidence from clinical and pre-clinical studies for modulation of the gut microbiome as a treatment for cirrhosis and associated neuropsychiatric conditions.

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Implementing pragmatic clinical trials in hepatology.

A trial's pragmatism is based on the efficiency by which it identifies, recruits, and follows patients, the degree to which the interventions and design mirrors usual clinical care, and the importance of the outcomes to the patients. We review the promise, tradeoffs, and purpose of pragmatic trials in hepatology.

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The evolving knowledge on primary hemostasis in patients with cirrhosis: A comprehensive review.

Further investigations into the in vivo interplay between platelets, circulating blood elements, and endothelial cells may help advance our understanding of cirrhotic coagulopathy. Here, we review the complex changes in platelets and primary hemostasis in cirrhosis, and their potential clinical implications.

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J Hepatol

MicroRNA-27a-3p targets FoxO signalling to induce tumour-like phenotypes in bile duct cells.

The miRNomes of CCA tissues are highly remodelled, impacting transcriptome homeostasis in part through regulation of transcription factors like FOXO1. MiR-27a-3p arises as an oncogenic vulnerability in CCA. Impact and implications Cholangiocarcinogenesis entails extensive cellular reprogramming driven by genetic and non-genetic alterations, but the functional roles of these non-genetic events remain poorly understood. By unveiling global miRNA upregulation in patient tumours and their functional ability to increase proliferation of cholangiocytes, these small non-coding RNAs are implicated as critical non-genetic alterations promoting biliary tumour initiation. These findings identify possible mechanisms for transcriptome rewiring during transformation, with potential implications for patient stratification.

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Reviews&Editorials

Plenty of the editorials are available as full text through the publisher website using the provided link

Aliment Pharmacol Ther

Review article: Functional dyspepsia-a gastric disorder, a duodenal disorder or a combination of both?

Future research for the treatment of FD should focus on the inhibition of duodenal mast cell activation, eosinophilia and loss of mucosal integrity.

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Clin Gastroenterol Hepatol

"Alcohol-associated liver disease: integrated management with alcohol use disorder".

Progress has recently been made in the management of patients severe AH which have improved survival through better understanding of the concept of response to medical treatment, improved survival prediction and the advent of early LT. The emerging concept is that listing for transplantation a patient with severe ALD could lead to adjusting the duration of abstinence according to the severity and evolution of liver dysfunction and the patient's addictive profile.

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Blue Notes.

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Disaggregating Racial and Ethnic Data: A Step Toward Diversity, Equity, and Inclusion.

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Evidence Synthesis to Advance Clinical Practice and Scientific Research:A CGH Pillar.

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Modern Day Approach to Extra-Esophageal Reflux: Clearing the Murky Lens.

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Endosc Int Open

EUS-guided liver biopsy: the optimal technique?

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Gastroenterology

The Gut Microbial Bile Acid Modulation and its Relevance to Digestive Health and Diseases.

We also highlight the emerging role for modifying the gut microbiome to improve health or to treat disease, including the "engineered native bacteria'' approach that takes bacterial strains from a patient, modifies them to alter metabolism, and re-introduces them. Taken together, study of the metabolites derived from the gut microbiome will provide insights into a wide range of physiological and pathophysiological processes, and has substantial potential for new approaches to diagnostics and therapeutics of disease of or involving the gastrointestinal tract.

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J Hepatol

Methotrexate-induced liver fibrosis: the end of a long-held belief.

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Paediatric Autoimmune Hepatitis: time to change the textbooks?

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Neurogastroenterol Motil

Improving access to gut-directed hypnotherapy for irritable bowel syndrome in the digital therapeutics' era: Are mobile applications a "smart" solution?

While adherence was low, those that completed smart phone-delivered GDH-achieved symptom benefit. This mini-review summarizes the current evidence-base for available modalities of GDH and discusses the current and future utility and development of mobile health applications in the digital therapeutics' era.

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Miscellaneous

misc publications eg case reports, tools of the trade, images of the month, etc…

Am J Gastroenterol

Calendar of Courses, Symposiums and Conferences.

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Exploring GI Diseases Across the Lifespan.

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Long-term major papilla metastasis from lobular breast cancer mimicking ampullary neoplasm: an endoscopic ultrasound diagnosis.

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Use of the Stethoscope to Diagnose Gastrointestinal and Hepatic Disorders.

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Clin Gastroenterol Hepatol

Incorporating Artificial Intelligence into GI practices.

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Terlipressin Treatment is Associated with Reversal of Hepatorenal Syndrome in Patients with Alcoholic Hepatitis.

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Endoscopy

A "clip-thread-elastic ring" internal traction device for endoscopic submucosal dissection of a duodenal tumor.

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A challenging endoscopic approach to an unexpected case of extraluminal recurrence after rectal surgery.

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A novel cap-assisted endoscopic resection device for resection of a rectal lesion in an in vitro pig model.

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A novel technique of endoscopic introducer-assisted transpapillary gallbladder aspiration prior to drainage in a patient with acute cholecystitis.

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A shot in the light: rendezvous endoscopic ultrasonography-guided pancreatic duct drainage in treatment of recurrent pancreatitis with pancreas divisum.

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Abnormal bronchial artery mimicking esophageal submucosal tumor.

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Application of a "retracting flaps" technique using a device delivery system for endoscopic removal of a pancreatic stent with 10 proximal flaps stuck in the pancreatic duct.

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Are we ready for the cold snare revolution?

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Deeper endotracheal intubation offers generous views for endoscopic submucosal dissection of cervical esophageal carcinoma.

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Direct anorectal intubation during colonoscopy: a logical new paradigm.

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Early esophageal squamous cell carcinoma and diverticulum were cured simultaneously by endoscopic submucosal dissection in a patient.

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Endoscopic coagulation for massive bleeding from a gallbladder ulcer after endoscopic ultrasound-guided gallbladder drainage.

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Endoscopic drainage and necrosectomy for inoperable gangrenous cholecystitis.

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Endoscopic fenestration treatment for pneumatosis cystoides intestinalis in patient with recurrent colonic intussusception.

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Endoscopic management of food impaction following endoscopic ultrasound-guided gallbladder drainage using lumen-apposing metal stent.

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Endoscopic submucosal resection with adaptative traction device: a new strategy to facilitate resection in patient with inflammatory bowel disease.

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Endoscopic ultrasound-guided rendezvous in pancreas divisum with a nondilated pancreatic duct.

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Endoscopy E-Videos - recently published.

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Gel immersion cannulation during hemostasis of post-endoscopic sphincterotomy bleeding.

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Giant gastric stromal tumor with predominant cystic formation misdiagnosed as gastric cyst under endoscopic ultrasonography and fine-needle aspiration.

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Inner countertraction facilitating endoscopic submucosal dissection of a difficult early gastric cancer independent of transparent cap.

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Management of multiple esophageal leaks with an ultra-large fully covered metallic stent after aborted peroral endoscopic myotomy.

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Novel use of lumen-apposing metal stent for recanalization of complete stenosis of colo-colonic anastomosis.

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Oral anticoagulants and fecal immunochemical tests for hemoglobin: do they go together?

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The "squeezing with forceps" method for emergency endoscopic removal of an impacted pancreatic stone in the papilla of a patient on antithrombotic therapy.

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Gastrointest Endosc

Diagnosis and approach to gastric polyps.

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Letters&Replies

Letters to the editors and authors’ replies

Clin Gastroenterol Hepatol

Cardiovascular and liver diseases in subjects with sarcopenic obesity and nonalcoholic fatty liver disease.

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Letter to the Editor: Risk Stratification for Sarcopenic Obesity in Nonalcoholic Fatty Liver Disease.

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Gut

Gastric cancer risk in autoimmune gastritis: evidence versus opinion.

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J Hepatol

Enhance the picture by improving the focus.

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Genetic variants improve hepatocellular carcinoma risk stratification, only in alcoholic cirrhosis patients?

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Global incidence of primary liver cancer by Etiology Among children, adolescents, and young adults.

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